Laryngeal keel

ABSTRACT

A laryngeal keel is disclosed that is effective in preventing the recurrence of anterior glottic stenosis after surgical correction thereof. The keel is molded from silicone rubber and includes a flexible extralaryngeal portion and a flexible keel portion dimensioned to extend through the anterior commisure and sufficiently thin to ensure that said commisure is sharp and that the thyroid laminae can be closely approximated. The extralaryngeal portion is dimensioned to umbrella the area of the anterior commisure to prevent the escape of laryngeal secretions by way of the thyrotomy and to be sutured securely to the thyroid laminae. The flexibility of the umbrella portion minimizes asynchronous motion between the keel and the vocal cords. These factors, together with the inertness of the silicone rubber ensure re-epithelialization of the incised tissue in engagement therewith.

United States Patent Montgomery et al.

[54] LARYNGEAL KEEL [72] Inventors: William W. Montgomery, 3 Wachusett Road, Wellesley, Mass. 0218i; Eugene B. Hood, 211 Vine Street, Duxbury, Mass. 02330 a 221 Filed: Nov. 5, 1970 21 Appl. No.: 87,094

[56] References Cited UNITED STATES PATENTS 4/1970 Deane ..l28/l R 5/1941 Grossman et al. ..l28/l R OTHER PUBLICATIONS McNaught Laryngoscope 60: Mar. 1950; pp. 264-272.

[ 1 Dec. 26, 1972 Dedo et al. Annals of Otology, Vol. 77, 1968, pp.

Primary Examiner-Dalton L. Truluck Attorney-Abbott Spear 57 ABSTRACT A laryngeal keel is disclosed that is effective in preventing the recurrence of anterior glottic stenosis after surgical correction thereof. The keel is molded from silicone rubber and includes a flexible extralaryngeal portion and a flexible keel portion dimensioned to extend through the anterior commisure and sufficiently thin to ensure that said commisure is sharp and that the thyroid laminae can be closely approximated. The extralaryngeal portion is dimensioned to umbrella the area of the anterior commisure to prevent the escape of laryngeal secretions by way of the thyrotomy and to be sutured securely to the thyroid laminae. The flexibility of the umbrella portion minimizes asynchronous motion between the keel and the vocal cords. These factors, together'with the inertness of the silicone rubber ensure re-epithelialization of the incised tissue in engagement therewith.

6 Claims, 6 Drawing Figures PATENTED I973 3. 707. 1 5O sum 1 or 2 FIG. I

INVENTORS WILL/AM w. MONTGOMERY EUGENE 8. H000 BY Wm,

AT ORNEY LARYNGEAL KEEL The present invention relates to laryngeal keels for use in preventing the recurrence of anterior glottic stenosis after surgical correction thereof.

The treatment of anterior glottic stenosis has been unsuccessful in a significant number of cases even with the procedure which utilizes an approach to the stenosis by way of an anterior thyrotomy and a tantalum keel inserted, after correction of the stenosis, between the vocal cords and provided with oppositely'disposed extralaryngeal tabs apertured to permit their being sutured to the thyroid laminae. The keels were removed after a 6 to 8 week period. In a substantial number of cases, the stenosis recurred and anterior cordal granulation was found to be present so that this procedure, though until now regarded as the most effective, left much to be desired.

It has been recognized that re-epithelialization of the incised tissues is essential to prevent reformation of the stenosis. It is apparent that such re-epithelialization did not occur in those cases where the stenosis recurred and where granulomas resulted.

' The objective of the present invention is to provide larnygeal keels that will prevent such objectionable post-operative results in substantially all cases, an objective attained with a laryngeal keel of an inert plastic material and comprising an extralaryngeal anchoring portion and an intralaryngeal keel portion, both then are flexible, the keel portion being dimensioned to extend through the anterior commissure from end-to-end thereof and the anchoring portion being dimensioned to umbrella the thyrotomy in the area of said commissure.

The keel portion is desirably as thin as possible thus to permit the thyroid laminae to be closely approximated and the umbrella portion is sufficiently thin to conform to the contours of the thyroid laminae and to holdthe sutures by which the keel is secured and the thyrotomy tightly closed and with the flexibility of the keel preventing asynchronous motion between the laryngeal portion of the keel and the vocal cords.

In the drawings, there is shown an embodiment of the invention illustrative of these and other of its objectives, novel features, and advantages.

In the drawings:

FIG. 1 is a view showing a laryngeal keel sutured to the thyroid laminae;

FIG. 2 is a section, on an increased scale, taken approximately along the indicated Iines 2-2 of FIG. 1;

FIG. 3 is a section, on a further increase in scale, taken approximately along the indicated lines 3-3 of FIG. 1;

FIG. 4 is a view of the keel as seen from the anterior end thereof, the keel being shown substantially full size;

FIG. 5 is a side view thereof; and

FIG. 6 is an end view of the keel.

A laryngeal keel in accordance with the invention is generally indicated at 10 and includes, see FIGS. 4, 5, and 6, an extra-laryngeal or umbrella portion 11 and an intralaryngeal keel portion 12 extending at right angles thereto and terminating short of the ends of the umbrella portion 11 as will be apparent from FIG. 5. The margins of the umbrella portion taper as at 13 and the keel portion 12 has a tapered edge 14. The keel 10 is is formed from a plastic that is inert with respect to body secretions and both portions are thin and flexible. In

practice, silicone rubber is used in the production of the keels l0 and has proved to be satisfactory in actual use in a substantial number of cases. In practice, the keel portion 12 is in the neighborhood of 0.014 inches in thickness except for its edge 14 while the central, thickest part of the umbrella portion 11 is in the neighborhood of 0.050 inches.

Before further describing the keel 10, reference is made to FIGS. l-3. The anterior commissure of the vocal cords 15 is generally indicated at 16 and is, see FIG. 2, located posteriorly of the thyroid cartilage l7. Glottic stenosis is a transverse web in this area and to enable it to be repaired, a horizontal incision 18 is made where it enables the thyroid membrane, the thyroid cartilage, and the cricothyroid membrane to be exposed. A vertical midline thyrotomy 20 is effected enabling access to the area of the stenosis to be made.

After the repair of the stenosis, the intralaryngeal portion 12 of the keel is inserted. The thyroid laminae 21, see FIG. 3, above and below the umbrella portion of the keel 10 are then approximated with the suture indicated at 22. The keel 10 is then secured by suturing it to the thyroid laminae as by two figure-of-eight sutures 23, each passing through the umbrella portion 11 and through the keel portion 12 adjacent its junction therewith.

At this point, it should be noted that the height of the keel portion 12, i.e., its vertical extent when sutured in place, must be at least equal to the corresponding extent of the anterior commissure 16 and that the dimensions of the extralaryngeal portions 11 must be such as to cover or umbrella the thyrotomy 20 in the area of the anterior commissure. The length of the keel portion 1 1 must be such as to extend through the incised tissue in the anterior commissure 16, for example 16 mm for use in the case of a male larynx and 12 mm for the larynx of a female or child. It may, of course, be trimmed as needed.

While the thinness of the umbrella portion 11 enables it to conform to contours of the thyroid laminae to which it is sutured the thinness of the keel portion 12 not only permits the thyroid laminae marginally thereof to be closely approximated and a sharp anterior commissure to be established but also provides such flexibility that asynchronous motion between it and the vocal cords is effectively minimized.

A keel in accordance with the invention permits regrowth of vocal cord epithelium enabling it to be removed within a 2 or 3 week interval without complicating granulomas in the region of the vocal cords. At the same time, it allows a more complete closure of the anterior commissure to minimize laryngeal secretions into the extralaryngeal spaces by way of the thyrotomy. In addition, because of the fact that the umbrella portion 12 conforms to the contour of the thyroid laminae due to its flexibility when secured thereto, the keel is securely fixed. This factor, together with the flexibility of the keel portion contributes to prevent asynchronous motion between the keel portion and the vocal cords.

We claim:

1. A laryngeal keel for use in preventing the recurrence of anterior glottic stenosis following surgical correction thereof, said keel being of a flexible inert plastic material comprising an extralaryngeal anchoring portion to be sutured to the thyroid laminae laterally of the anterior commissure, and an intralaryngeal keel portion emerging from the central part of the anchoring portion and dimensioned, when inserted in the thyrotomy, to extend through the anterior commissure and of a length to extend from end-to-end thereof, said anchoring portion extending beyond the ends of the keel portion and being of a width throughout its length to over lie and completely cover the margins of the thyrotomy at the anterior commissure from end-to-end thereof and to provide an area adequate for keel-retaining suturing, said anchoring portion being sufficiently thin and flexible throughout-to enable it to be sutured to the thyroid laminae and then to conform to the external contour thereof, said keel portion being sufficiently thin and flexible to establish a sharp anterior commissure and to enable the suture to extend through said keel portion and effect the drawing of the margins of the thyrotomy against the sides of the keel portion to prevent the escape of laryngeal secretions via the thyrotomy, the thinness and flexibility of both portions preventing asynchronous motion between the keel portion and the vocal chords which factors, with the inertness of the material, ensure complete re-epithelialization of the incised adjacent tissues.

2. The keel of claim 1 in which the plastic material is silicone rubber.

3. The keel of claim 1 in which the thickness of the keel portion is in the order of 0.014 inches.

4. The keel of claim 1 in which the maximum thickness of the umbrella portion is in the order of 0.050 inches.

5. The keel of claim 1 in which the maximum thickness of the keel portion is in the neighborhood of 0.014 inches and the maximum thickness of the umbrella portion is in the neighborhood of 0.050 inches.

' 6. The keel of claim 1 in which the umbrella-portion is flat and its margins taper substantially to a knife edge. 

2. The keel of claim 1 in which the plastic material is silicone rubber.
 3. The keel of claim 1 in which the thickness of the keel portion is in the order of 0.014 inches.
 4. The keel of claim 1 in which the maximum thickness of the umbrella portion is in the order of 0.050 inches.
 5. The keel of claim 1 in which the maximum thickness of the keel portion is in the neighborhood of 0.014 inches and the maximum thickness of the umbrella portion is in the neighborhood of 0.050 inches.
 6. The keel of claim 1 in which the umbrella portion is flat and its margins taper substantially to a knife edge. 